translational microbiology laboratory by j. scott vanepps
Post on 22-Jan-2017
139 Views
Preview:
TRANSCRIPT
J. Scott VanEpps, MD, PhD
I have no conflicts of interest to disclose
Half of the 2 million annual healthcare-associated infections in the U.S. can be attributed to indwelling medical devices
Devices implanted by EPs Central lines
Endotracheal tubes
Foley catheters
Despite over a decade of effort, infected devices remain the most common cause of healthcare-associated bloodstream infection
Protection from host defense
Prevent diffusion of humoral factors
Kills neutrophils
Protection from antibiotics
Restricted diffusion
Reduced metabolic activity
Small molecule degradation
Persister cells
Antimicrobial zinc oxide nanoparticles
Thermal treatment of biofilms in situ
Nanorod-PCR (NR-PCR) for rapid detection of bacteremia
Pyramids Spheres Plates
McGuffie et al., Nanomedicine, 2015
McGuffie et al., Nanomedicine, 2015
Sturtevant et al., Shock, 2015
Richardson et al., ASAIO J, 2015
Richardson et al., ASAIO J, 2015
Richardson et al., ASAIO J, 2015
Richardson et al., ASAIO J, 2015
Chiroplasmonic Nanorod-PCR (NR-PCR) for rapid determination of bacteremia and antibiotic
resistance in sepsis
Scenario: Septic patient presents to the Emergency Department Fever, confused, elevated heart rate, decreased blood pressure What is the source? What is the bug? Which antibiotic?
Current goal: Administer broad spectrum antibiotics in the first hour De-escalate to targeted therapy ASAP1
Problem: Blood cultures are the current gold standard Long time to result (24-72hrs)2
Low sensitivity and specificity3
Limited viral and fungal identification3
Result: One-size-fits-all Antibiotic resistance (MRSA, VRE) Opportunistic infection (C. dificile) Life threatening side effects (renal and hepatic failure) Undertreatment of critically ill patients
Blood Sample
Culture (12-24hrs)
Speciation (12-24hrs)
Antibiotic Sensitivity (12-24hrs)
NR-PCR (≈3 hrs)Gram +/-
Organism
Targeted therapy
Blood Sample
Antibiotic resistance genes
Targeted therapy
Time to result = 36-72hrs Time to result ≈3 hrs
Organism
Best limit of detection: 160zM (10-21)
Best time to result: 2 hrs
What next: Compare to blood culture Evaluate CD wavelength vs
transcript length Develop melt curve equivalent Growth in presence of Abx
VanEpps Lab: Matt McGuffie Usha Kadiyala Rachael Sturtevant Nina Grossman Carolyn Vitale
Younger Lab: Prannda Sharma Ian Richardson Marika Raff
Solomon Lab: Elizabeth Stewart Maria Tianhui Joanne Beckwith
Michael Heung, MD Kotov Lab:
Jin Hong Joong Hwan Bahng Gleiciani Silveira
Yue Wang Green Lab:
Emmanouil Glynos
NIH NIGMS MCubed MCIRCC SAEM NSF CVC DOD EMF
top related